Abstract: TH-PO584
Isolated Intrarenal Mucormycosis Due to Rhizopus Species in a Pediatric Renal Transplant Recipient
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Bagley, Kiri W., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Sanderson, Keia, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Primack, William A., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Introduction
Mucormycosis (MM) is an unusual but well-known complication of solid organ transplant, which disseminates aggressively with a high mortality rate. Our patient may be the first reported child with isolated renal allograft MM.
Case Description
3-y.o. female, with ESRD due to hypoplastic/dysplastic kidneys, received a cadaveric renal transplant after basiliximab induction, with subsequent pred, tac, and MMF. 4 weeks post Tx she developed fatigue, tachypnea, and increase in SCr to 1.7 from baseline of 0.4. UA revealed moderate LE, + nitrites, many WBCs and RBCs, and moderate bacteria. Renal US showed mildly distended ureter and renal pelvis with collecting system debris. She received broad-spectrum antibiotics. Renal biopsy showed tac toxicity. She stabilized and was discharged on reduced tac. Antibiotics discontinued as urine culture was negative.
5 weeks post-discharge, she redeveloped fever, pyuria, and rising SCr. US showed thickened ureter and renal pelvis. Parenteral antibiotics were resumed. Urine culture was negative. Repeat UA showed less but persistent pyuria. Antibiotics broadened on hospital day (HD) 2 due to unremitting fever. Steroid pulse on HD 3 for possible rejection. Fever abated on HD 4, and steroids tapered after no rejection on biopsy (HD 6). Tachycardia, new fever (HD 7) and tachypnea (HD 8) developed with progressive abdominal distention. US showed fluid collections within allograft. Rhizopus sp. was identified from intrarenal fluid aspirate, and amphotericin and posaconazole were begun. Transplant nephrectomy occurred the next day. CNS, chest, abdomen, and pelvis imaging were negative for disseminated MM. After nephrectomy, catheterized UA was benign. 10 days post-op, she developed new fever. Laparotomy showed no disease spread. Other organ recipients from same donor did not develop MM.
She received a 3-month posaconazole course with clinical improvement. She was discharged after 2-month hospitalization. She has been off antifungal therapy for >1 month, and is doing well on outpatient hemodialysis.
Discussion
MM is a rare, usually disseminated complication of renal transplant with mortality reported as >50% when graft involvement occurs. MM isolated to the renal allograft is unusual. Clinicians should consider the possibility of intrarenal allograft MM with bacteriologic culture negative patients with pyuria.